Beliefs and knowledge of osteoporosis amongst female graduate students in Karachi, Pakistan: A cross-sectional study.

OBJECTIVE: To assess the knowledge, belief and preventive measures taken regarding osteoporosis by students of different non-medical educational backgrounds. METHODS: The descriptive cross-sectional study was conducted from January to March, 2018, at one private-sector and two public-sector universities in Karachi, and comprised female participants aged >15 years from engineering, commerce, social and pure sciences background. Osteoporosis Knowledge Assessment Tool questionnaire was self-administered to collect data which was analysed using SPSS 23. RESULTS: There were 400 females with a mean age of 20.55±1.66 years. The overall mean score was 46.49±12.83 and 43(10.8) subjects had a good score, 204(51%) had an average score and 150(37%) had a poor score regarding knowledge about osteoporosis. Also, 186(47%) subjects identified previous studies as their source about osteoporosis, 103(26%) gained knowledge by health professionals and 62(16%) did it through electronic media. The knowledge on risk factors, protective factors and perceived susceptibility were significant (p<0.05) when compared by type of study and age. CONCLUSIONS: The knowledge of the disease was found to be insufficient, indicating need for generating awareness regarding osteoporosis.

Knowledge and awareness regarding spread and prevention of COVID-19 among the young adults of Karachi.

OBJECTIVE: To measure the awareness of COVID-19 infection among the general population following the outbreak in China. METHODS: This descriptive cross-sectional study was carried out during January and February 2020 amongst the general population of Karachi, Pakistan. A pre-tested, self-administered questionnaire was used among 399 young adult participants. The questionnaire was developed keeping in view of the already published study on severe acute respiratory syndrome (SARS) and the available literature on COVID-19. It included sociodemographic information, assessment of knowledge, beliefs regarding coronavirus and the perception of precautionary measures taken by an individual. Chi-square test was used for categorical variables and p<0.05 was used as statistically significant. RESULTS: There were more females 299 (75%) than male participants 100 (25%). The mean age was 20.9 ±2.30 years and 232 (58%) had graduate degrees. There is lack of knowledge and awareness about coronavirus as 226 (56.6%) participants claimed that coronavirus is actually the most dangerous virus in the world, and 171 (43%) did know that the common flu virus is potentially more lethal than coronavirus. Although a large majority of participants correctly identified sources of transmission, measures and precautions to be taken for coronavirus, their knowledge for symptom identification was deficient. The most pursued platform for information for coronavirus was found to be social media, followed by television and print media. CONCLUSIONS: The study highlighted the level of awareness of coronavirus among young adults in Karachi, Pakistan. The study further pointed out the public knowledge gaps for the authorities concerned to help them develop more effective and successful awareness campaigns using preferred channels.

Smartphone addiction and its associated behaviors among medical and dental students in Pakistan: A cross-sectional survey.

INTRODUCTION: Addiction refers to the irresistible urge to engage in certain actions or dependence on a particular substance despite knowing negative consequences. The current study evaluated the severity of Smartphone addiction and the factors associated with cell phone-like activity. MATERIALS AND METHODS: This cross-sectional study was conducted from July to August 2019 among medical and dental students in Karachi, Pakistan. A pretested self-administered questionnaire was used among 400 students. The mobile phone addiction was assessed using a 20-item, Mobile Phone Addiction Scale. A two-stage cluster analysis was used to assess mobile phone addiction-like behaviours. Chi-square test was used to find associations between categorical variables. Kolmogorov-Smirnov to test normality of data were also used. A P < 0.05 was considered to be statistically significant for all tests. RESULTS: Out of the total 400 students, the majority 316 (79%) comprise female students. The mean age was 20.54 ± 1.59 years. In 184 (48%) students, there was evidence of mobile phone addiction-like behavior. The prevalence was higher in female than male students and among older compared to adolescent students; the differences were statistically nonsignificant. A higher median score ≥ of 4 is found in questions related to components reflected intense desire, impaired control, and tolerance and harmful mobile use. CONCLUSION: This study highlights that a large number of students are addicted to their smartphones. Smartphone addiction continues to be the most problematic addiction aided by the presence of intense desire, impaired control tolerance, and harmful mobile use. The phenomenon must be fully understood to draw deeper and richer inferences about the origins of this addictive behavior, which is becoming more prevalent in our Pakistani society on a daily basis.

Fragility index: how fragile is the data that support the American College of Gastroenterology guidelines for the management of Crohn's disease?

Randomized controlled trials (RCTs) are the cornerstone of evidence-based medicine. However, recent literature has drawn attention to the limitations of using P-value to report statistical significance of outcomes in the clinical trials. We performed this analysis to analyze the strength of the data that supported the American College of Gastroenterology (ACG) guidelines for 'Management of Crohn's disease in adults' using fragility index (FI). We screened all the RCTs referenced in the 2018 ACG guidelines 'Management of Crohn's disease in adults'. We calculated the FI and the fragility quotient (FQ) and its correlation with P-value. Data were also collected on the patients lost to follow up, year of publication, sample size, number needed to treat (NNT), science citation index (SCI), presence of blinding and the number of centers in these studies. Of the 91 RCTs cited in this guideline, 32 RCTs met the inclusion criteria. The median values for FI for 32 trials were 3 [interquartile range (IQR) 2-6], FQ 0.026 (IQR 0.012-0.413), P-value 0.010 (IQR 0.001-0.03), lost to follow up 17 (IQR 10-39.5) and sample size 133 (IQR 74.5-281.5). There was statistically significant correlation between FI and P-value (rs -0.86, P <0.001) and sample size (rs 0.56, P = 0.002). There was no correlation found with number lost to follow up, NNT, SCI, year of publication, blinding and number of centers. The majority of the RCTs conducted in the field of Crohn's disease rely on small number of superior events for statistical significance, thus rendering the validity of their conclusion questionable. At least 18 out of 60 ACG recommendations are based on RCTs in which, number of patients lost to follow up exceeds FI, thus making reported outcomes of the trial weak. We suggest that FI and FQ should be included in clinical trials to better understand if the data are meaningful, beyond a P-value.

Reexamining the data used in the 2012 guidelines of the American Association for the Study of Liver Diseases for the management of adult patients with ascites due to cirrhosis.

BACKGROUND: In 2012, the American Association for the Study of Liver Diseases published practice guidelines for the management of patients with ascites caused by cirrhosis, using data from randomized controlled trials (RCTs) and observational studies. We reexamined the strength of these RCTs by calculating the fragility index (FI), a novel metric proposed for evaluating the robustness of RCTs. METHODS: We screened all RCTs referenced in the guidelines for specific criteria. We calculated the FI and fragility quotient (FQ), and analyzed the correlation between FI and several variables. RESULTS: Twenty-one RCTs were included. The median (25th, 75th) FI and FQ were 1 (interquartile range [IQR] 0.5-6) and 0.070 (IQR 0.008-0.166), respectively. For studies that reported the number of patients lost to follow up (12 RCTs), the median of patients lost was 2 (IQR 0-6.5). There was no significant correlation between FI and sample size (rs=0.357), P-value (rs=-0.299), number lost to follow up (rs=0.355), Science Citation Index (rs=0.347), year of publication (rs=-0.085), blinding (rpb=-0.18) or number of centers (rpb=0.10). However, a significant correlation was seen between FI and number needed to treat (rs=-0.549; P=0.015). CONCLUSIONS: RCTs in the field of cirrhosis-related ascites are fragile. Of the 21 trials analyzed, 13 had an FI of 3 or below and these trials influenced 13 of the 49 recommendations in the guidelines. We recommend the incorporation of FI and FQ in addition to P-value to better understand the meaning of the results in gastroenterological studies.